Seppä Karri, Malila Nea, Pitkäniemi Janne
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
Acta Oncol. 2020 Nov;59(11):1316-1321. doi: 10.1080/0284186X.2020.1772500. Epub 2020 Jun 18.
Monitoring regional variation in population-based cancer survival is useful for assessing equity in national health-care system. This study quantifies variation in survival between municipalities and hospital districts responsible for primary care and for specialised care, respectively, in Finland.
Five-year relative survival of 11 cancers and close to 700,000 patients was estimated by municipality in Finland over 1962-2016 using hierarchical Bayesian modelling. Variation (i) between hospital districts, (ii) between municipalities within hospital districts, and (iii) between all municipalities (total variation) were quantified by the standard deviation of 5-year relative survival standardised by the average survival level.
In 2007-2016, the largest variation in 5-year relative survival between all municipalities was in stomach, prostate, kidney and liver cancer and skin melanoma. In male skin melanoma, prostate, and kidney cancer and in male and female pancreatic cancer, there was substantial and statistically significant variation between hospital districts, too. Variation within hospital districts was on average 67% (95% posterior interval [58%,76%]) out of the total variation and had decreased by 18% [2%, 33%] from 1997-2006.
The decrease in variation within hospital districts suggests that equity in diagnostics and primary care has improved in Finland. However, the variation between hospital districts in skin melanoma, prostate and kidney cancer reflects differences in early diagnostics. In pancreatic cancer, substantial variation between hospital districts may relate to regional differences in the accessibility and the quality of cancer treatments.
监测基于人群的癌症生存率的地区差异，有助于评估国家医疗保健系统的公平性。本研究量化了芬兰分别负责初级保健和专科护理的各市镇与医院区之间的生存率差异。
采用分层贝叶斯模型，估算了1962 - 2016年芬兰各市镇11种癌症近70万名患者的五年相对生存率。通过以平均生存水平标准化的五年相对生存率的标准差，量化了（i）医院区之间、（ii）医院区内各市镇之间以及（iii）所有市镇之间的差异（总差异）。
在2007 - 2016年，所有市镇之间五年相对生存率差异最大的是胃癌、前列腺癌、肾癌、肝癌和皮肤黑色素瘤。在男性皮肤黑色素瘤、前列腺癌和肾癌以及男性和女性胰腺癌中，医院区之间也存在显著且具有统计学意义的差异。医院区内的差异平均占总差异的67%（95%后验区间[58%，76%]），并且与1997 - 2006年相比下降了18%[2%，33%]。
医院区内差异的减少表明芬兰在诊断和初级保健方面的公平性有所改善。然而，皮肤黑色素瘤、前列腺癌和肾癌在医院区之间存在差异反映了早期诊断方面的差异。在胰腺癌中，医院区之间的显著差异可能与癌症治疗的可及性和质量的地区差异有关。
